Sao Paulo Med. J. vol.134 número5

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Sao Paulo Med J. 2016; 134(5):461-2 461

LETTER TO THE EDITOR

DOI: 10.1590/1516-3180.2016.0080080516

Gamma-glutamyl transferase and pulmonary embolism

Gama glutamil transferase e embolia pulmonar

Sevket Balta

I

_{, Cengiz Ozturk}

II

_{, Mustafa Demir}

III

_{, Ali Osman Yildirim}

IV

_{, Turgay Celık}

V

Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey

Dear Editor,

We read the article “Elevated gamma glutamyl transferase (GGT) levels are associated with the location of acute pulmonary embolism. Cross-sectional evaluation in hospital setting” by Korkmaz et al.1_{hey concluded that there was a signiicant association between increased}

embolism load in the pulmonary artery and increased serum GGT levels.

Several noninvasive tests have been used for accurately diagnosing pulmonary embolism. Some inlammatory markers like red cell distribution width may show pulmonary embo-lism through further diagnostic tests.2_{In addition, mean platelet volume may describe or}

predict pulmonary embolism.3_{Tests for these markers are routine, available and accessible}

through any laboratory. Serum GGT activity is a marker of oxidative stress and endothelial dysfunction. We previously showed that serum GGT level may be an independent marker for the severity of cardiovascular diseases.4_{Korkmaz et al.}1_{showed the correlation between GGT}

and acute pulmonary embolism. However, some important issues need to be considered. Firstly, GGT determination is one of the hepatic function tests. Presence of GGT may change any form of hepatic dysfunction even if no overt liver disease is present. Secondly, Gilbert syn-drome is frequently seen worldwide. his synsyn-drome may be correlated with hepatic function tests. GGT is also a widely measured serum enzyme: it almost speciically shows biliary epi-thelial damage and generally indicates excessive alcohol intake. GGT is released from many tissues such as the liver, kidney, cerebrovascular endothelium and pericytes.5_Furthermore,

changes in serum GGT levels can be afected by waist circumference and body mass index, hypertension, diabetes, hyperuricemia and genetic factors. Lastly, admission troponin levels were assessed in the recent study by Korkmaz et al.,1_{but the patients seemed to have a}

rela-tively long duration of symptoms before admission, which may have led to underestimation of the potential impact of troponin.

In conclusion, although GGT levels were associated with pulmonary embolism in the study published in this journal,1_{GGT levels alone may not provide enough information to diagnose}

these patients, unless the factors outlined above are also taken into consideration. herefore, we believe that GGT should be evaluated under these conditions. We believe that these indings will be clariied through further studies.

I_{MD. Staf Cardiologist, Department of Cardiology,}

Gulhane Medical Academy, Ankara, Turkey.

II_{MD. Associate Professor of Cardiology,}

Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey.

III_{MD. Resident of Cardiology, Department of}

Cardiology, Gulhane Medical Academy, Ankara, Turkey

IV_{MD. Resident of Cardiology, Department of}

Cardiology, Gulhane Medical Academy, Ankara, Turkey.

V_{MD. Professor of Cardiology, Department of}

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LETTER TO THE EDITOR | Balta S, Ozturk C, Demir M, Yildirim AO, Celık T

462 Sao Paulo Med J. 2016; 134(5):461-2

REFERENCES

1. Korkmaz O, Yucel H, Zorlu A, et al. Elevated gamma glutamyl

transferase levels are associated with the location of acute pulmonary

embolism. Cross-sectional evaluation in hospital setting. Sao Paulo

Med J. 2015;133(6):488-94.

2. Balta S, Karademir I, Demir M, et al. Red cell distribution width in

pulmonary embolism. Wien Klin Wochenschr. 2014;126(17-18):553-4.

3. Balta S, Demirkol S, Unlu M, et al. Higher mean platelet volume level

in patients with pulmonary embolism. Clin Respir J. 2014;8(2)251-2.

4. Ulus T, Yıldırır A, Sade LE, et al. [Serum gamma-glutamyltransferase

activity: a new marker for coronary artery bypass graft disease]. Turk

Kardiyol Dern Ars. 2011;39(3):205-13.

5. Cakar M, Balta S, Demirkol S, Altun B, Demirbas S. Serum

gamma-glutamyltransferase (GGT) should be evaluated together with other

inlammatory markers in clinical practice. Angiology. 2013;64(5):401.

Date of irst submission: April 3, 2016

Last received: April 16, 2016

Accepted: May 8, 2016

Address for correspondence:

Sevket Balta

Department of Cardiology

Gulhane School of Medicine, Tevik Saglam St., 06018, Etlik, Ankara, Turkey

Tel. +90 312 3044281

Fax. +90 312 3044250